Manage Your Bipolar Disorder Triggers and Cut Your Symptoms in Half

Being manic and experiencing a trigger are two different things. Learning to avoid what sets you off is extremely important to managing your bipolar disorder.

When I was first diagnosed with bipolar disorder at age 31, I was completely unaware of the triggers that caused my mood swings. I blindly walked into situations and never thought, “Gee! This might make me sick!”

It’s amazing to me that no one at the time taught me about triggers and how they could significantly increase bipolar disorder symptoms. Certainly if they had, I would have found my stability much sooner. Other than medications, trigger recognition + avoidance is now my number one management tool. What is a trigger? I’d define it as anything outside of the illness that causes mood swings. In my experience, triggers are not the result of bipolar disorder mood swings—they are the cause.

When I get manic, I may stay up all night drinking and singing karaoke—my behavior is therefore a direct result of the illness. I used to get caught up in this—for days, I’d think, “Oh no! I’m manic!” My option here was to prevent the mania that caused the behavior.

A trigger is different. Here’s an example of how an outside trigger can cause significant mood swings. A few years ago, I began a friendship with a brilliant woman who shared my career of writing books. We began a joint project, but she became aggressive and very dismissive of my work. I’d never been around a verbally abusive person, so I talked to her about it and she apologized. Then she did it in public; she actually slammed her fist on the table she was so angry. I left and began crying in my car; within an hour I went into a downswing and had suicidal thoughts. I finally left the relationship for good. By removing myself from the situation, the mood swings completely went away. Her loss!

It took me way too long to recognize my two main triggers: dating and too much work. It’s like being allergic to sunlight and water as far as I’m concerned— what’s life if you can’t find a partner, or do something professionally that you really love? It makes me sad even to write this.

Here’s another illustration: A friend of mine did so well at work that he was promoted to manager. Within two months, however, he was seriously manic even though his last manic episode had occurred 13 years earlier. For this friend, the trigger was an exciting promotion. In my case, as soon as I get a book deal, I become ecstatic, then depressed—simply from the pressure of my success.

Many times, I’ve called my friends and said, “I just got a great offer for a book! Let’s celebrate before I get sick.” It’s not fair, but it’s the reality of bipolar disorder.

Controlling triggers

Before all this gets too depressing, I want to give you the great news. When I learned to manage my triggers, I cut my bipolar symptoms by at least 50 percent— trigger management helps that much! This is because triggers are external, which means I can control many of them. My main problem is dealing with the sadness and frustration that accompany giving up certain things I enjoy. Deciding what you can and cannot handle is very difficult indeed.

Eventually, after years of struggling with what I wanted to do—versus what I could actually handle—I had to answer a serious question: What is more important to me, stability—or having fun and taking risks? For many years, I tried to make a deal with the devil on these choices: “I’ll just do it a little—it won’t make me sick this time. I can date and stay out until 2 a.m. I’ll just sleep more the next day. My friends do it.”

But I’m not my friends. I have a serious mental illness that has to be managed 24 hours a day, if I wish to remain stable. Weeks of depression and psychosis occasioned by a thoughtless decision are too serious to play around with. Because of this reality, I now choose stability over “fun.”

I once asked my mom what she considered my main triggers. She considered the question for quite a while, then replied, “Anything that messes up your schedule.” Well, that’s just great—that includes about everything! She’s right, though.

The mood chart

I now have a trigger management tool in place to keep me as stable as possible. Each night I chart my moods—I’ve done this for six years. I draw a line down a page in my journal. The top of the line is mania; below the line is depression. An “X” means anxiety, a “P” is psychosis, an up-and-down line represents rapid cycling. Beneath each day, I write a few things that happened. This way, I can carefully chart the path of my mood swings, as they relate to the events in my day.

For example, I can have a pretty normal day and then I go way, way down because of an argument with my brother. This means I write “Fight with Ed” on the line that represents a downswing. After doing this for a few years, I was absolutely amazed at what consistently triggered the illness and how I just kept doing those things anyway—I really was in denial.

I once dated a man who had a lot of issues. I loved him, but he triggered so many mood swings that my chart often looked like an EKG. I used to think I was the problem, until I really looked at how much I was affected by his behavior. When I left the relationship, the mood swings stopped completely. Later, if I saw him or if he upset me on the phone, I once again began the free-fall into depression.

I can also see how much I’m affected by holidays like Christmas. I also know that saying yes to too much work can trigger agitated mania. And worries about my brother can make me suicidal. Yes, troublesome relationships affect me that seriously.

Without my mood chart, I’m not sure that I would be so aware of what makes me sick. I sometimes feel like a monk, but the trigger management is working. I am able to enjoy my life in many ways. The more stable I become, the more I can handle certain triggers in small doses. For instance, I can travel again! I’m also able to speak in public and to work a lot more than was previously the case. This comes from avoiding other triggers such as dating and agreeing to projects simply because they may stroke my ego or sound so exciting.

In fact, sometimes you can trade one trigger for another and thus minimize the damage. To get sleep without medications, I now say goodnight to friends at 11 p.m. Furthermore, I ask people to help me carefully monitor my choices. I’m far more resilient; I surround myself with “consistent” people who don’t upset my schedule. Finally, no matter how hard it is, I walk away from situations that make me sick.

It’s been 13 years since my diagnosis. Avoiding the triggers that cause mood swings has saved my life. I’m so thankful I figured it out.

* * * * *

Questions to ask yourself about potential triggers

Are there signs that I’m getting sick due to a current situation?

Am I letting excitement get in the way of reality?

Am I really seeing the whole picture?

Are people telling me to be careful?

Is the person or situation I’m attracted to causing mood swings?

Am I walking into a situation that made me sick in the past?

Answering these questions can help you detect even the smallest of triggers. Then you can answer the main question: What is more important—continuing behavior that triggers mood swings—or savoring lovely, wonderful stability?

About the author

Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get It Done When You’re Depressed, and The Health Cards Treatment System for Bipolar Disorder. She is a columnist and blogger for bp Magazine, and she won the Mental Health America journalism award for the best mental health column in the US. Julie was also the recipient of the Eli Lilly Reintegration Achievement Award for her work in bipolar disorder advocacy. Julie is a bipolar disorder expert for ShareCare, a site created by Dr. Oz and Oprah. Julie is CEU certified and regularly trains health care professionals, including psychiatric residents, social workers, therapists, and general practitioners, on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People magazine. She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called "Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis, and Depression." You can find more about her work at JulieFast.com and BipolarHappens.com.

66 Comments

I was diagnosed with Bipolar Disorder at 26. Since then I’ve taken my medication and seen my therapist quite regularly (I had started as a teen since I was suffering from clinical depression) but as long as I took my medication and took good care of me (I am a very BP-conscious kind of patient, well compensated) I had no problems with triggers or anything. Sure I was not up all the time but my life went on quite well. Only when together with my psychiatrist I stopped taking my medication to have a child I had another episode and it took me 3 years to recover completely. But in general with medication, therapy I take good care of myself and do not have to worry much about triggers (even if I am avare that some situations do make me feel unstable)… I am sorry, and astonished, to hear that other patients live such an unstable life… with medication and therapy my life is quite ordinary, I guess I am lucky to be so well aware of how I feel and to ask for help immediately if I don’t feel well. Good life to everyone

As Xmas approaches, this article becomes particularly relevant. I have broken with family tradition and am spending the holidays alone. My family didn’t protest at all!! But still there are Xmas parties, carol-singing gigs, cards to write although I have banned gifts. But I am not drinking (much) and limiting activities. I have to be careful as I am without therapy until January, as my long-term psychiatrist has retired with cancer. I have my TV and will go to the movies, concerts, theater, enjoy the decorations, go for walks. And church! – the only really meaningful meaning on the festivities. My 1st delusional manic episode was one Xmas 32 years ago, and I want to avoid another. Good luck to all of you.

I’m in love with my best friend, but she is married. She loves me too but needs to make her marriage work. Everytime she spends time with her husband it upsets me, it’s definitely a trigger. First thought was not to be around her anymore but the problem is we’re best friends and I need her in my life. She has helped me through so much. Please help, what can I do?

I’ve gotten more clarity from this one post than I’ve had in my entire life. This brought me to tears. I really need to seek help but I just don’t. Not until I am backed into a corner and have no option would I probably consider reaching out to a Dr. or professional. I really need to understand the definition of self care. This truly encourages me to take a small step forward.

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